Iv basics anatomy and physiology
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Iv basics anatomy and physiology

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Iv basics anatomy and physiology Iv basics anatomy and physiology Presentation Transcript

  • IV THERAPY - AN OVERVIEW
    Anatomy , Physiology& Basic Concepts of IV Fluids
    Dr.Ravindar Bethi, MD
    Specialist , Anesthesia & ICU,
    Al Rass General Hospital, KSA.
  • IV THERAPY - AN OVERVIEW
    Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein.
  • IV THERAPY - AN OVERVIEW
    Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body.
  • IV THERAPY - AN OVERVIEW
    Neat and clear diagram needed
    It is commonly referred to as a drip because it employs a
    drip chamber,
    which prevents
    air entering the blood stream
    (air embolism)
    and allows an estimate of
    flow rate.
  • FLUIDS AND
    ELECTROLYTES
    IV THERAPY - AN OVERVIEW
    More clear pictures needed
    ANATOMY AND PHYSIOLOGY
  • ANATOMY AND PHYSIOLOGY
    See ACLS print out material for text and pictures
    Dorsal venous arch
  • ANATOMY AND PHYSIOLOGY
    Basilic vein
  • ANATOMY AND PHYSIOLOGY
    Cephalic vein
  • ANATOMY AND PHYSIOLOGY
    dorsal veins of forearm
  • ANATOMY AND PHYSIOLOGY
  • ANATOMY AND PHYSIOLOGY
    Medial cubital vein
  • ANATOMY AND PHYSIOLOGY
    Brachial artery
    Medial cubital vein
  • Brachial artery
    Medial cubital vein
    Median Nerve
    ANATOMY AND PHYSIOLOGY
  • Femoral Vein
    Dorsal venous arch
    Great Saphenous Vein
    ANATOMY AND PHYSIOLOGY
  • ANATOMY AND PHYSIOLOGY
    Scalp Veins
  • Extra-vasation pictures needed
    …the new access site has to be proximal to the "blown" area to prevent extravasation of medications through the damaged vein…
  • …for this reason it is advisable to site the first cannula at the most distal site on the vein.
  • Interosseous Route
    The only alternative in emergency that is equally reliable
    What is next best ?
    ACLS
  • ANATOMY AND PHYSIOLOGY
  • Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
  • Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
  • Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    ADVANTAGES
    • Fluids irritating to peripheral veins can be given
    • Chemotherapy
    • Total parenteral nutrition
    • Medications reach the heart immediately, and are quickly distributed to the rest of the body.
    • Central venous pressure can be measured
  • Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    DISADVANTAGES
    • Risks of bleeding, infection, air embolism.
    • Technically difficult–
    • needs experienced clinician knowing the appropriate landmarks and/or
    • using an ultrasound probe to safely locate and enter the vein.
    • Pleura and carotid artery are at risk of damage with the potential for pneumothorax or puncture/ cannulation of the artery.
  • Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    INTERNAL JUGULAR
    • Nursing care
    • Be cautious with potassium
  • Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    SUBCLAVIAN
    • Nursing care is easier
    • Open even in shock
    • Incompressible
  • Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    FEMORAL
    • Emergency situations where it is difficult to cannulate Internal jugular vein or Subclavian vein
    • High risk of infection
    • Preferred for potassium infusions
  • Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    Some more photos are to be collected and placed here
  • Central Venous Line Vs Pulmonary Artery Catheter
  • Some special types of
    Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    Peripherally inserted central catheter
    ADVANTAGES
    • Safer to insert with a relatively low risk of uncontrollable bleeding
    no risks of damage to the lungs or major blood vessels.
    • With proper hygiene, care, can be left in place for several weeks for patients who require extended treatment.
  • Some special types of
    Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    Peripherally inserted central catheter
    DISADVANTAGES
    • Must travel through a relatively small peripheral vein which can take a less predictable course on the way to the superior vena cava . Hence, more technically difficult to place in some patients.
    • Travels through the axilla. Hence, can become kinked causing poor function.
  • Some special types of
    Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    Tunneled Lines
    Hickman line or Broviac catheter
    • “Tunneled" under the skin to emerge a short distance away. from the central vein
    • Reduced risk of infection, since bacteria from the skin surface are not able to travel directly into the vein;
    • Catheters are also made of materials that resist infection and clotting.
    A Hickman line in a
    leukemia patient.
    It is tunneled under the skin to the jugular vein
  • Some special types of
    Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    Implantable ports
    • Silicone rubber reservoir, implanted under the skin.
    • Medication is injected via its silicone cover, into the reservoir.
    • The cover can accept several hundreds of needle sticks during its lifetime. It is possible to leave the ports in the patient's body for years.
  • Some special types of
    Central Venous Lines
    Central Lines flow through a catheter with its tip within a large vein, usually the
    superior vena cava or inferior vena cava, or within the right atrium of the heart.
    Implantable ports
    • Needs regular maintenance. If it is plugged a thrombus can form with the accompanying risk of embolisation
    • Commonly used for patients on long-term intermittent treatment.
  • IV Fluids
    Crystalloids
    Colloids
    Replace with actual photos of our hospital
  • IV Fluids
    Colloids
  • IV Fluids
    Crystalloids
  • IV Fluids
    Colloids
    • Contain larger insoluble molecules, such as albumen.
    • Preserve a high colloid osmotic pressure in the blood
    • Blood itself is a colloid.
  • IV Fluids
    Colloids
  • IV Fluids
    Crystalloids
    • Aqueous solutions of water-soluble molecules.
    • The most commonly used crystalloid fluid is normal saline=, a solution of sodium chloride at 0.9% concentration, which is close to the concentration in the blood (isotonic).
    • What is isotonic?
    • What is Iso-osmolar ?
  • IV Fluids
    Crystalloids
  • IV Fluids
    Crystalloids
  • IV Fluids
    Crystalloids
    Replace with actual photos of our hospital
    isotonic
    • Fluid of choice in multiple situations
    • Trauma
    • Metabolic alkalosis
    • Not to be given in hyperchloremic acidosis
  • IV Fluids
    Crystalloids
    Replace with actual photos of our hospital
    hypotonic
  • IV Fluids
    Crystalloids
    • Iso-osmolar , compared
    to Normal Saline
    • Hypotonic to
    the human cells
    due to Insulin
    • Hypertonic in insulin deficiency
    ? Isotonic/ Hypotonic
    • Isotonic in vitro
    • Hypotonic in vivo
  • IV Fluids
    Crystalloids
    ? Isotonic/ Hypertonic ?
  • IV Fluids
    Crystalloids
    Replace with actual photos of our hospital
    Nearly Isotonic
    Contains calcium, potassium and Lactate
    • Don’t give in alkalosis
    • Don’t give in hyperkalemia
    • Don’t give with Blood
    • Mind its Calcium content, when giving with Mg therapy
  • IV Fluids
    Crystalloids
    Replace with actual photos of our hospital
    • Don’t give potassium therapy with Dextrose containing solutions
    • When giving Dextrose containing solutions, add KCl to prevent hypokalemia
    • When giving KCl in the treatment ofhypokalemia, don’t add it to solutions containing Dextrose.
  • Distribution of fluid in human body
    Crystalloids move up to here
    DRAW NERVE CELLS
    PICTURE OF WATER GAMES IN WATER
    Colloids stay here
  • Risks and complications of IV THERAPY
    Infection
    Phlebitis
    Infiltration and extravasation
    Embolism
    Fluid overload
    Electrolyte Imbalance
  • Electrolytes
    Sodium 135 – 145 mmol/L
    Potassium 3.5 – 5.0 mmol/L
    Calcium 2.12 – 2.75 mmol/L
    ( Ionised calcium 1.0-1.3 mmol/L)
    Magnesium 1.5 – 2.2 m Eq/L
    Phosphorous 0.81 – 1.20 mmol/L
  • Electrolytes
    Sodium 135 – 145 mmol/L
    Potassium 3.5 – 5.0 mmol/L
    Calcium 2.12 – 2.75 mmol/L
    Magnesium 1.5 – 2.2 m Eq/L
    Phosphorous 0.81 – 1.20 mmol/L
    Low sodium – lower osmolality
    High sodium – higher osmolality
  • Sodium 135 – 145 mmol/L
    Potassium 3.5 – 5.0 mmol/L
    Calcium 2.12 – 2.75 mmol/L
    ( Ionised calcium 1.0-1.3 mmol/L)
    Magnesium 1.5 – 2.2 m Eq/L
    Phosphorous 0.81 – 1.20 mmol/L
    Electrolytes
    More DETAILS AND MORE PICTURES needed, ABOUT ALL THE ELECTROLYTES
    Hypokalemia
    Hyperkalemia
    Is it ACLS 2005?
  • Hyperkalemia
    Sodium 135 – 145 mmol/L
    Potassium 3.5 – 5.0 mmol/L
    Calcium 2.12 – 2.75 mmol/L
    ( Ionised calcium 1.0-1.3 mmol/L)
    Magnesium 1.5 – 2.2 m Eq/L
    Phosphorous 0.81 – 1.20 mmol/L
    BE
    GOOD
    IN
    CLINICAL
    SKILLS
    KEEP
    DRUGS
    AWAY
    • Bicarbonate
    • Glucose +
    • Insulin
    • Calcium
    • Sorbitol
    • Keyexalate
    • Dialysis
    • Albuterol
    More DETAILS AND MORE PICTURES needed, ABOUT ALL THE ELECTROLYTES
    Is it ACLS 2005?
    ACLS - 2006
  • Electrolytes
    Sodium 135 – 145 mmol/L
    Potassium 3.5 – 5.0 mmol/L
    Calcium 2.12 – 2.75 mmol/L
    ( Ionised calcium 1.0-1.3 mmol/L)
    Magnesium 1.5 – 2.2 m Eq/L
    Phosphorous 0.81 – 1.20 mmol/L
  • EVERYTHING IS RELATED TO EVERYTHING ELSE
    THANK YOURAVINDAR BETHI